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Medicine > Renal > Flashcards

Renal Flashcards

1
Q

What are some pre renal causes of AKI?

A 
Hypovolaemia 
Hypotension (Sepsis, shock, anaphylaxis)
Congestive HF
Liver cirrhosis
Renal hypoperfusion (NSAIDs, ACEi, Renal artery stenosis)
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2
Q

What are some intrinsic renal causes of AKI?

A

ATN due to nephrotoxic agents (e.g. contrast, cisplatin, aminoglycosides)
ATN due to ischaemia
Glomerular Disease
Vasculitis

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3
Q

What are some post renal causes of AKI?

A

Renal stones
Blood clots
Urethral structure
Tumours

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4
Q

What are the criteria to diagnose an AKI?

A

Rise in serum creatine of 26+ umol/L in 48hrs
50% or greater rise in serum creatine in preceding 7 days
A drop in urine output to 0.5ml/kg/hr for 6 hours

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5
Q

How would you manage a px with an AKI?

A

Treat cause (if sepsis, Abx O2 and fluids, if post renal then catheterise)
Stop any nephrotoxic drugs
Catheterise and monitor fluid balance (aim for euvolaemia)
Monitor for complications (eg hyperK+tx with IV calcium gluconate, IV insulin and dextrose, nebulised salbutamol)

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6
Q

Oliguria is a urine output less than what?

A

0.5ml/kg/hour

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7
Q

What are some causes of CKD?

A 
Diabetes Mellitus
HTN
SLE, vasculitis 
Polycystic kidney disease
Glomerulonephritis 
Scarring of kidneys from repeated infections
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8
Q

How would CKD kidneys appear on USS?

A

Shrunken (<9cm)

Hydronephrosis

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9
Q

What is the GFR for each stage of kidney disease?

A 
1 >90ml/min
2 60-89ml/min
3a 45-59ml/min
3b 30-44 ml/min
4 15-29ml/min
5 <15ml/min
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10
Q

What investigations would you do for suspected CKD?

A 
FBC (anaemia due to less EPO)
U&amp;Es
GFR
Urine dip 
HbA1c 
Screen for antibodies eg ANCA
USS
Biopsy (only in some cases eg if normal kidneys on scan)
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11
Q

Why class of Abx are contraindicated in renal failure?

A

Aminoglycosides

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12
Q

How would you managed a px with CKD?

A

Optimise BP control
Control any diabetes
Loop diuretics for oedema
If anaemia, optimise iron/ folate/ B12 levels and can give EPO if persistent
Calcium and vitamin D supplements and phosphate binders for osteodystrophy
Monitor CVD risk eg statin and aspirin
Low phosphate and low salt diet, restrict fluid intake
End stage renal failure needs renal replacement

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13
Q

CKD is based on decreased kidney function for how long?

A

At least 3 months

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14
Q

Why does hyperphosphataemia occur in CKD and what can this lead to?

A

Insufficient filtering of phosphate
This can increase PTH secretion, leading to hyperparathyroidism
This can lead to renal bone disease

Can tx by offering a phosphate binder

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15
Q

How can metabolic acidosis be treated in CKD?

A

Oral sodium bicarbonate tablets

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16
Q

Why is IV calcium gluconate given in hyperkalaemia?

A

This is cardioprotective (will not correct high K+, hence other drugs need to be given to do so)

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17
Q

What is a differential for AKI, more likely when rise in urea is proportionately bigger than the rise in creatine?

A

Dehydration

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18
Q

How would you manage a px at risk of an AKI who is having a scan that requires contrast?

A

Temporarily stop drugs eg ACEi, A2RB

Give IV fluids before and after to reduce risk

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19
Q

Goodpastures syndrome affects which type of collagen?

A

Type IV

20
Q

What is a normal anion gap?

A

8-14 mmol/L

21
Q

How does nephrotic syndrome present (triad)?

A

Proteinuria (>3.5g/day) causing hypoalbuminaemia and hence oedema

22
Q

What are some causes of nephrotic syndrome?

A
  • diabetic nephropathy
  • FSGS
  • membranous GN
  • minimal change GN
  • SLE
23
Q

How much proteinuria is indicative of nephrotic syndrome?

A

> 3.5g/24hr

24
Q

How would you treat nephrotic syndrome?

A
  • loop diuretics
  • renal biopsy (to confirm diagnosis, nephrotic syndrome alone is not a diagnosis)
  • blood pressure control (ACEi/ A2RB)
  • steroids (especially good for minimal change)
  • reduce salt in diet
25
Q

What is minimal change glomerulonephritis?

A

Type of nephrotic syndrome
Common in children
In adults can be idiopathic, paraneoplastic or from drugs eg NSAIDs
Responds to steroids

26
Q

What is focal segmental glomerulosclerosis?

A

Type of nephrotic syndrome
Can be idiopathic, or due to IgA strep, Alpert syndrome, vasculitis, sickle cell, heroin, HIV
Scarring of glomerular segments

27
Q

What is membranous glomerulonephritis?

A

Type of nephrotic syndrome
Thickened basement membrane with immune complex deposits
Can be idiopathic or associated with malignancy/ hep B/ drugs e.g. NSAIDs, penicillin, gold/ autoimmune eg SLE

28
Q

What are some complications of nephrotic syndrome?

A
  • increased infection susceptibility because of lost immunoglobulin in urine
  • thromboembolism (hypercoagulable state due to loss of natural anticoagulants protein C and S, and increased clotting factors)
  • hyperlipidaemia
29
Q

How does nephritic syndrome present?

A

Haematuria
High BP
Mild proteinuria (not as much as nephrotic syndrome)

30
Q

What are some causes of nephritic syndrome?

A

IgA nephropathy
SLE
Goodpastures Disease

31
Q

What is IgA nephropathy?

A

Commonest GN in the world
Type of nephritic syndrome
Often due to post-strep chest infection so increased IgA forms deposits on the cells

32
Q

What is Goodpastures Disease?

A

Causes type of nephritic syndrome
Auto antibodies to type 4 collagen in the glomerular basement membrane
Can also affect lungs and cause pulmonary haemorrhage (so haemoptysis as well as haematuria)

33
Q

Which type of nephritic syndrome could present with haemoptysis as well as haematuria?

A

Goodpastures syndrome

34
Q

Which antipsychotic drug can cause polyuria?

A

Lithium

35
Q

At what GFR should dialysis be started?

A

<15L/min

36
Q

What drugs are potentially nephrotoxic and should be stopped in AKI?

A 
ACEi
NSAIDs
Aminoglycosides
Diuretics 
A2RBs
37
Q

How would you minimise the chance of AKI in a patient requiring contrast?

A

Ensure they are adequately hydrated with 1L 0.9% saline pre and post op

38
Q

What are some indications for renal replacement therapy?

A 
Uraemia
Acidosis
Hyperkalaemia
Toxins
Fluid overload
39
Q

What variables are need to input into the formula to calculate eGFR?

A

Age
Sex
Serum creatinine
Ethnicity

40
Q

What are some symptoms of uraemia?

A 
Anorexia
Altered mental state
Pruritis
Weakness
Vomiting
Restless legs
Fatigue 
Amenorrhoea
Impotence
Bone pain
41
Q

How will a patients U&Es look if they have severe CKD?

A

Low Ca
High phosphate
High PTH (secondary hyperparathyroidism)
Raised ALP

42
Q

What type of anaemia can be caused by CKD?

A

Normochromic normocytic anaemia

43
Q

What are some absolute contraindications to renal transplantation?

A

Active infection
Cancer
Severe comorbidities/ heart disease
Hyperkalaemia

44
Q

What are some complications of haemodialysis?

A

Hypotension
Infection/ thrombosis/ stenosis of AV fistula
Time consuming (3x week)

45
Q

What are some complications of peritoneal dialysis?

A

Peritonitis
Obesity (due to glucose in dialysate)
Hernias
Loss of membrane function over time

Medicine (7 decks)

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